Preterm births are responsible for 75% of neonatal mortality and one-half of long-term neurological impairments in children as well as a substantial portion of all birth-related short- and long-term morbidity. In the United States, about 12.8 percent of babies (more than 500,000 per year) are born prematurely. The rate of premature birth has increased by 36 percent since the early 1980s. Rates of low birth weight babies are higher in medically underserved and minority populations-even when issues such as access and insurance coverage are accounted for. Preterm births account for 30% of all health care spending on infants and 10% of spending for children. Societal costs in the US are estimated at $26 billion annually. Although most preterm births occur in women who do not have any of the few known risk factors for preterm birth some women are clearly at greater risk than others. Researchers have identified some modifiable lifestyle risk factors and medical conditions associated with preterm births that can be addressed during pregnancy. Timely screening and management of modifiable risks and evidence-based care can potentially reduce risks for preterm labor. Yet providing effective prenatal risk management systems in a clinical setting to meet the unique needs of medically underserved women is complex. Timely screening and management of modifiable conditions can reduce preterm births and improve maternal and child quality of life. However, providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. The goal of this proposal is to test the efficacy of a clinic-based, computer-assisted intervention system to reduce preterm births in high-risk, underserved populations. This system will: (1) assess a pregnant woman's unique risks in six modifiable areas associated with increased risks of preterm birth including smoking cessation, poor nutrition, domestic violence, maternal depression and stress, urinary and reproductive tract infections and substance use;(2) provide her with tailored advice on reducing her risks;(3) provide counseling suggestions and action planning tools for that woman's physician or certified nurse midwife specifically tailored for the patient's needs;and [(4) encourage referrals from the clinic as well as follow-up to ensure that she is successful in utilizing services from community-based organizations to help with complex problems such as domestic violence and substance use/abuse-when they exist.] In this proposed program, we will test the ability of the system to (1) reduce rates of births less than 37 weeks and birth weights less than 2500 grams;and (2) change behaviors that can reduce risks using a balanced prospective randomized controlled multi-site trial with 452 patients during prenatal care clinic visits beginning during the 1st trimester. This proposal would build on a successful Phase I study where we assessed the acceptability and feasibility of this system with patients and their physician and/or certified nurse midwife. PUBLIC HEALTH RELEVANCE: Preterm births account for 30% of all health care spending on infants and 10% of spending for children. The preterm birth rate has risen 36% since the early 1980s. Timely screening and management of modifiable conditions can reduce preterm births, yet providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. If the proposed system proves to be effective in reducing preterm births it can improve maternal and child quality of life as well as reduce the economic burden of preterm births in the U.S.